Clinical notes from American Society of Haematology

high-dose melphalan and total body irradiation followed by transplantation with certain subsets of patients. Among the unpurged autologous bone marrow that patients who were in chronic phase at the was collected after two cycles of time of BMT, who were less than 50 years VMCP/BVAP. Patients in both arms of old, who were transplanted from an the study received maintenance treatment HLA-matched donor, and who were with alpha interferon. Response rate was within 1 year of diagnosis, the probability improved in the ABMT patients with 38% of surviving 3 years was 74% compared achieving complete or very good partial with 56% for patients less than 50, who response, compared with on 14% of the were transplanted from an HLA-matched patients receiving conventional treatment. donor more than 3 years after time of 5-year post-diagnosis event-free survival diagnosis (p=0012) and 40% for patients was 28% (95% CI=18-40) in the ABMT arm versus 10% (95% CI=3-27) in younger than 50 transplanted from an HLA mismatched donor more than 3 the CC arm (p=001). The 5-year postof survival was 52% years after diagnosis (p=0006). The data diagnosis probability demonstrate the importance of optimising (95% CI=36-67) in the ABMT arm verHLA matching and of donor selection sus 12% (95% CI=2-46) in the CC arm early in the disease, the researchers (p<0-03). EA Mesri of Cornell University Medconcluded. : ical College, New York reported that he Researchers from Purpan Hospital in and his colleagues had identified a new Toulouse, France, reported that patients transmissible herpes virus from AIDSwith multiple myeloma (MM) treated associated Kaposi’s sarcoma and from with high-dose chemotherapy followed AIDS-related body-cavity-based lymwith autologous bone marrow transplanThe virus is encapsidated and Bphomas. tation had improved response rate, eventspecifically lymphotropic, infecting free survival and overall survival rate B CD19+ cells. Mesri said infection of B when compared with patients treated with cells the dubbed human virus, by herpes conventional chemotherapy (CC). In the cause KS lesions by stimustudy, 200 patients under the age of 65 virus 8, might the release of cytokines. The lating with intermediate to high-tumour-mass found that researchers foscarnet blocks (stage II/III DS) untreated MM were raninfection a finding, Mesri said, HHV8, by domised at time of diagnosis to either that suggests this drug may be a possible conventional chemotherapy (VMCP/ treatment for Kaposi’s sarcoma. BVAP; vincristine, melphalan, cyclophosphamide, prednisone/vincristine, carmusor Michael McCarthy tine, doxorubicin, prednisone)

Clinical notes from American The ican

opening plenary session of the AmerSociety of Haematology’s annual

conference this week included three presentations of clinical interest. Researchers from Seattle’s Fred Hutchinson Cancer Research Centre reported that in selected patients with chronic myeloid leukaemia (CML), results of bone marrow transplantation (BMT) with marrow from unrelated donors can approach those of patients who received marrow from HLAidentical siblings. : The 3-year survival rate of CML patients transplanted while they are still in the chronic phase of their disease with marrow from HLA-identical siblings is : approximately 80%. In the Seattle study, 321 CML patients underwent unrelated donor transplants. 194 were in chronic phase (CP), 70 in accelerated phase (AP), 16 were in second chronic phase (CP2), and 32 were in blast phase(BP). : Their median age was 36-1 (range 5 to 55 years). Patients were pre-treated with cyclophosphamide and total body irradiation and received methotrexate and cyclosporin for graft-versus-host disease prophylaxis. 76% of patients were matched with their donor for HLA-A, B, BRB 1. The remainder had at least one minor mismatch for HLA-A, or DR. : The probability of survival at 3 years was 60% for patients transplanted in CP, 39% in AP, 35% in CP2, and 6% in BP. But results were considerably better in

Society of Haematology

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strated clear separation of grey scale valfor calcified and fibrous tissues, but NASCET and ECST trials took different poor specimen separation between lipid neasurements from the arteriograms, and haemorrhagic regions; for MRI, lipid vhich yielded quite different assessments was clearly identified but there was poor )f percentage carotid stenosis (Stroke :separation between haemorrhagic and cal.994; 25: 2435-49). If no consensus cified regions (AJ Arnold, London, UK). exists about how to measure the degree of However, it is important to recognise that ;arotid stenosis from an angiogram, magnetic resonance chemical shift imagletailed comparisons with alternative ing (Br Heart 1989; 62: 81-89) may be a more refined technique than simple MR ion-invasive techniques may prove diffi:ult. Methodological issues aside, in one grey scale analysis for differentiating :entre in the USA carotid surgery was between the constituent components of reported to be based in 90% of cases on atherosclerotic plaques. Furthermore, iuplex studies-thus, where possible, the studying the fibrous cap of such plaques 1eed for IADSA examinations was may also yield useful information about avoided. Intra-arterial cerebral contrast the risk of plaque rupture (D E Strandstudies carry an equal risk of stroke and ness). Delegates were reminded that while ieath as carotid endarterectomy (D E arteriography provides information about Strandness, Seattle, USA). : only the arterial lumen and internal vessel surface, both MRI and ultrasound permit Analysis of the morphology and constituents of carotid plaques may also the vessel surface and plaque lesions to be assist in predicting plaque rupture and studied. Thus combinations of MRA/MRI the risk of cerebrovascular events. Work and ultrasound analyses might permit not better non-invasive carotid stenosis on carotid plaques that used grey scale only determination than either test on its own, analysis from both B-mode ultrasound but in time also in-vivo plaque characteriand magnetic resonance imaging (MRI) This sation. would allow atherosclerotic were reported; specific components of the lesions at increased risk of rupture to be as such fibrous tiscalcification, plaques identified before clinical sequelae develop. and were ident’l-

Assessing the severity of carotid artery disease In 1991, both the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the European Carotid Surgery Trial (ECST) demonstrated conclusive benefit from carotid endarterectomy in symptomatic patients with 70-99% internal carotid artery (ICA) stenosis. Measurements of carotid stenosis in both studies were based on intraarterial carotid angiography, which carries with it a risk of stroke or death of about 1 %. For some time now there has been considerable interest in non-invasive measurement of carotid stenosis with alternative techniques such as duplex ultrasound and magnetic resonance angiography (MRA). These topics were discussed at the 27th Annual Scientific Meeting of the British Medical Ultrasound Society, held in Torquay, UK on Dec 5-7. Comparison of imaging methods for determination of the degree of ICA stenosis was reported. When intra-arterial digital subtraction angiography (IADSA) was used as the gold standard, the agreement with duplex ultrasound was 84%, and 79% for MRA (K B Modaresi, London, UK). However, it was suggested that no single current technique can be regarded as a true gold standard because the

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